Treatment as HIV prevention


    The AIDS Committee of Toronto (ACT) believes that HIV testing and treatment should be offered to all people living with HIV/AIDS, but no one should be forced to undergo either. No response to HIV/AIDS can work without the engagement and voluntary participation of people living with and at risk of HIV/AIDS.

    ACT supports universal access to anti-retroviral (anti-HIV) drug therapy and other treatments for HIV/AIDS, in Canada and around the world. ACT believes that access to HIV treatment is a right of all people living with HIV/AIDS.

    Recently, discussion has emerged around the potential of treatment to be used as an HIV prevention tool. Some researchers have projected that universal application of anti-retroviral treatment could stop the global HIV epidemic in its tracks, by reducing viral load and infectiousness among those living with HIV.1

    While ACT supports the laudable goal of increasing access to HIV treatment, we remain cautious about the implementation of a “treatment as prevention” approach for a number of reasons:
    • Treatment in settings without adequate viral load testing to identify cases of treatment failure could result in undetected viral rebound;2
    • Treatment in settings without access to second-line anti-HIV drug regimens could result in increased transmission of drug-resistant HIV;2
    • The application of anti-retroviral drug treatments that lower infectiousness, but are not medically necessary, may have negative health impacts on those living with HIV/AIDS;3 and,
    • Universal application of treatment violates the human rights of people with HIV/AIDS by removing the choice of when to begin anti-retroviral therapy.

    ACT supports a comprehensive approach to the HIV/AIDS crisis. Universal access to HIV treatment is a part of the prevention response to HIV/AIDS. However, any response must respect the health and human rights of people living with and at risk of HIV/AIDS, and be delivered in combination with other HIV prevention methods, including:
    • access to condoms (male and female/receptive) and other barriers;
    • the development of microbicides (for both vaginal and anal use);
    • pre- and post-exposure prophylaxis;
    • voluntary, confidential and anonymous testing for HIV and other sexually transmitted infections; and,
    • needle exchanges and other harm reduction initiatives.

    References:
    1 Montaner JSG et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. The Lancet 368: 531-536, 2006.
    2 Alcorn, Keith. Treatment as prevention tool: enough evidence to say it works, says IAS president. <http://www.aidsmap.com/en/news/30D49BD7-41FC-4E0D-AEBD-A210794D0533.asp>
    3 O’Neal, Reilly. Is HIV treatment HIV prevention? <http://www.thebody.com/content/art54536.html>